Boston public health authorities will likely approve a trial program providing heroin users with naloxone (brand name Narcan) next week, the Boston Globe reported Wednesday. If the Boston Public Health Commission indeed approves the program, it will join cities such as Baltimore, Chicago, and New York where authorities have already approved its distribution to drug users.

In many locales, only paramedics or hospital emergency rooms administer the drug, which can stop a heroin overdose from turning into an overdose death. But with Boston facing a high number of heroin overdose deaths -- fatal overdoses increased 50% between 1999 and 2003 -- city health officials want to put the drug where it can do the most good most quickly: in the hands of drug users.

"The number one hope with this is to save lives," Public Health Commission executive director Joel Auerbach told the Globe. "Our paramedics have said it's a miracle drug. They've seen people who are comatose who are then revived and perfectly fine."

The trial run is expected to enroll 100 heroin users, who would have to undergo training and evaluation, as well as listen to encouragements to quit. But if they were not prepared to stop using, they would be instructed in how to administer Narcan. Then they would be given a prescription for two doses.

When heroin users around Philadelphia started overdosing on junk laced with fentanyl, a powerful synthetic opiate, a local harm reduction group began working with a sympathetic physician to provide addicts prescriptions to naloxone (brand name Narcan). The Office of National Drug Control Policy thinks that's a bad idea.

In many cities, paramedics carry Narcan with them, but by the time they arrive on the scene, it can be too late, explained Casey Cook, executive director of Prevention Point Philadelphia, the group that runs the city's needle exchange program. "If people have to rely on paramedics, more often than not, the overdose is going to be fatal, just because of the amount of time for people to get there," she told the Associated Press in an interview last Friday.

But the drug czar's office is worried that providing addicts with the means to survive an overdose would prove "disinhibiting," much the same way social conservatives argue that providing teenagers with condoms to prevent pregnancy and disease "disinhibits" them from remaining abstinent. ONDCP doesn't want to appear to condone drug use. "We don't want to send the message out that there is a safe way to use heroin," said Jennifer DeVallance, an ONDCP spokesperson told the AP.

There were some 16,000 drug-related deaths reported in 2002, the vast majority of them involving either heroin or prescription opiates, and at least 400 people have died in the wave of fentanyl-related heroin ODs in the past few months. Better they should die than people think heroin is safe, huh?

American military commanders in Afghanistan Monday officially turned control of the country's restive, opium-rich south to NATO amid increasing rumblings of concern from European politicians -- concern over both rising coalition casualties and the wisdom of trying to prosecute the war on drugs and the counterinsurgency operation against the Taliban and Al Qaeda at the same time. With some 18,500 troops, it will be the biggest mission in NATO history, and one whose outcome is cloudy at best.

This year has seen an upsurge in fighting in Afghanistan, with some 1,700 people killed in the spreading violence so far. Among them are 65 US troops and 35 NATO troops, including three British soldiers killed Tuesday in an ambush in southern Helmand province and two more killed Wednesday. Last year, the bloodiest year yet for coalition forces, saw 129 US and NATO soldiers killed, but this year looks set to be bloodier yet. In the last three months alone, 58 NATO or American soldiers have been killed, 35 in the south. At the rate things are going, these figures will probably be outdated by the time you read this.

2005 Senlis symposium

It has also, by all accounts, seen an upsurge in opium production, especially in the south. Despite the stirring words of Prime Minister Karzai, who has vowed a holy war against the poppy, eradication efforts are achieving mixed results at best. That is because the Karzai government and its Western backers are confronted by a multitude of factors militating against success.

"The drug fight is continuing, but it is not very effective," said Abdul Raheem Yaseer, assistant director of the Center for Afghanistan Studies at the University of Nebraska-Omaha. "The lack of the government's ability to help farmers find markets and the difficulty of transporting goods on the bad roads are very discouraging. And now the area is suffering from drought," he told DRCNet. "People were optimistic at the beginning of the year that they could sell their produce, so they invested their money, and then the drought came. Now, many of them are saying they can't make back the money they spent, so they are shifting back to opium. They speak openly. They say 'We have families to feed, loans to pay, there is no water, there is no improvement in the roads.'"

Yaseer pointed to several factors hindering the eradication effort. "The drug lords have been benefiting for years, and they fight to keep that revenue going," he said. "The high rises going up in Kabul are all built by drug lords. But some of those drug lords are members of the government, which complicates matters even more. Karzai talks very tough about eradication, but the reality on the ground is quite different. The corruption, along with the lack of support within the government and by the West, allows the drug lords to enjoy a relatively peaceful time."

But if British Lt. Gen. David Richards, the new NATO commander in the south, has his way, the drug traffickers are about to feel the wrath of the West. "I'm convinced that much of the violence is only caused by the drugs-related activities in the south," said Richards at a Kabul press conference Saturday. "The opium trade is being threatened by the NATO expansion into the south and they are going to fight very hard to keep what they have got and a lot of what we are seeing has nothing to do with any ideological commitment" to the Taliban, he said. "Essentially for the last four years some very brutal people have been developing their little fiefdoms down there and exporting a lot of opium to the rest of the world. That very evil trade is being threatened by the NATO expansion in the south. This is a very noble cause we're engaged in, and we have to liberate the people from that scourge of those warlords."

"NATO has three objectives," said Yaseer. "Their first priority is to defeat the insurgency, secondly to win hearts and minds, and third to wipe out the opium." But, he conceded, those goals are contradictory, given Afghanistan's huge dependency on the opium economy. According to the United Nations, opium accounts for somewhere between 40% and 50% of the national economy.

And the attempt to prosecute all three objectives at the same time could well led to a more formal alliance between traffickers and insurgents. The major drug traffickers also align themselves with the Taliban and what Yaseer called "intruders" from Pakistan, referring to agents of Pakistani intelligence, the ISI, who he said work to keep Afghanistan from gaining stability. "The drug lords do not want to be controlled by the Afghan government, so they side with the intruders and the Taliban and share profits with them. These intruders from Pakistan are not helping; they are jeopardizing the efforts against smuggling and to eradicate the poppies. As for the Taliban, they might have religious problems with opium, but they like the money and they cooperate with the growers and traffickers."

"The drug lords and smugglers are as strong militarily as the Taliban and Al Qaeda," said Yaseer. "If they really unite together, the coalition forces will face a big strong resistance."

The command turnover from the Americans to NATO, and the rising death toll among NATO soldiers is beginning to focus the minds of European politicians, some of whom are beginning to call for the adoption of a scheme that would allow the licensed production of opium for the legitimate medicinal market. Formally unveiled last October in Kabul, the proposal from the European security and development think tank, The Senlis Council, has so far attracted only limited support from key decision-makers in Kabul and the capitals of the West.

"The Italian government will be a promoter both in Europe and in Afghanistan" of a project to "legally purchase the opium produced in Afghanistan and use it for medicinal purposes," said Italian foreign vice minister Ugo Intini last Friday, as he spoke with journalists at the Italian Senate. The aim is to reduce the illicit trafficking of opium and make opioid pain medications more available to poor developing countries, he said. The lack of opioid pain medications in the developing countries is "profoundly unfair," he added.

plaque memorializing journalists murdered by Taliban, at hotel where they stayed in Jalalabad

A British Labor Party politician told DRCNet Thursday that he, too, supported the Senlis proposal. "In Helmand, Britain has stopped destroying poppy crops to concentrate on bombing people into democracy and trying to win hearts and minds by using bombs and bullets," said MP Paul Flynn, a staunch opponent of the drug war. "The $40 million paid to the corrupt Karzai government to compensate farmers for crops previously destroyed never reached the farmers. The only sensible way to make progress is to license the farmers to use their poppy crop to reduce the world-wide morphine shortage."

But the idea that the US, which opposes any relaxation of any drug law anywhere on ideological grounds, or the Afghan government, will embrace the proposal is probably mistaken, said Yaseer. "As soon as you hear 'legalize drugs,' all kinds of religious, traditional, and other resistance pops up. One problem here is that the state is too weak. They can’t control it when it is illegal, and they wouldn’t be able to control it if it were legal. There is plenty of opium already without licensing; in the Afghan context, licensing means freedom to grow more."

Instead, said Yaseer, the Afghan government and the West should subsidize the farmers, seek alternative crops, and enable local government to actually establish control on the ground. But that will not be easy, he conceded. In the meantime, the poppies continue to bloom, the drug lords, both within and without the Karzai government, continue to get rich, and NATO soldiers, American soldiers, Taliban and Al Qaeda insurgents, and drug trafficker gunmen all continue to fight and die. And civilian Afghan citizens, most of whom would like nothing more than peace and prosperity, are among the biggest losers as the bullets fly and the bombs drop.